Mobile phones improve case detection and management of malaria in rural Bangladesh

Abstract Background The recent introduction of mobile phones into the rural Bandarban district of Bangladesh provided a resource to improve case detection and treatment of patients with malaria. Methods During studies to define the epidemiology of malaria in villages in south-eastern Bangladesh, an area with hypoendemic malaria, the project recorded 986 mobile phone calls from families because of illness suspected to be malaria between June 2010 and June 2012. Results Based on phone calls, field workers visited the homes with ill persons, and collected blood samples for malaria on 1,046 people. 265 (25%) of the patients tested were positive for malaria. Of the 509 symptomatic malaria cases diagnosed during this study period, 265 (52%) were detected because of an initial mobile phone call. Conclusion Mobile phone technology was found to be an efficient and effective method for rapidly detecting and treating patients with malaria in this remote area. This technology, when combined with local knowledge and field support, may be applicable to other hard-to-reach areas to improve malaria control.</p

Malaria hotspots drive hypoendemic transmission in the Chittagong Hill Districts of Bangladesh.

Malaria is endemic in 13 of 64 districts of Bangladesh, representing a population at risk of about 27 million people. The highest rates of malaria in Bangladesh occur in the Chittagong Hill Districts, and Plasmodium falciparum (predominately chloroquine resistant) is the most prevalent species.The objective of this research was to describe the epidemiology of symptomatic P. falciparum malaria in an area of Bangladesh following the introduction of a national malaria control program. We carried out surveillance for symptomatic malaria due to P. falciparum in two demographically defined unions of the Chittagong Hill Districts in Bangladesh, bordering western Myanmar, between October 2009 and May 2012. The association between sociodemographics and temporal and climate factors with symptomatic P. falciparum infection over two years of surveillance data was assessed. Risk factors for infection were determined using a multivariate regression model.472 cases of symptomatic P. falciparum malaria cases were identified among 23,372 residents during the study period. Greater than 85% of cases occurred during the rainy season from May to October, and cases were highly clustered geographically within these two unions with more than 80% of infections occurring in areas that contain approximately one-third of the total population. Risk factors statistically associated with infection in a multivariate logistic regression model were living in the areas of high incidence, young age, and having an occupation including jhum cultivation and/or daily labor. Use of long lasting insecticide-treated bed nets was high (89.3%), but its use was not associated with decreased incidence of infection.Here we show that P. falciparum malaria continues to be hypoendemic in the Chittagong Hill Districts of Bangladesh, is highly seasonal, and is much more common in certain geographically limited hot spots and among certain occupations

Subclinical Plasmodium falciparum infections act as year-round reservoir for malaria in the hypoendemic Chittagong Hill districts of Bangladesh

Objectives: An analysis of the risk factors and seasonal and spatial distribution of individuals with subclinical malaria in hypoendemic Bangladesh was performed. Methods: From 2009 to 2012, active malaria surveillance without regard to symptoms was conducted on a random sample (n = 3971) and pregnant women (n = 589) during a cohort malaria study in a population of 24 000. Results: The overall subclinical Plasmodium falciparum malaria point prevalence was 1.0% (n = 35), but was 3.2% (n = 18) for pregnant women. The estimated incidence was 39.9 per 1000 person-years for the overall population. Unlike symptomatic malaria, with a marked seasonal pattern, subclinical infections did not show a seasonal increase during the rainy season. Sixty-nine percent of those with subclinical P. falciparum infections reported symptoms commonly associated with malaria compared to 18% without infection. Males, pregnant women, jhum cultivators, and those living closer to forests and at higher elevations had a higher prevalence of subclinical infection. Conclusions: Hypoendemic subclinical malaria infections were associated with a number of household and demographic factors, similar to symptomatic cases. Unlike clinical symptomatic malaria, which is highly seasonal, these actively detected infections were present year-round, made up the vast majority of infections at any given time, and likely acted as reservoirs for continued transmission

Odds of asymptomatic infection in high & medium incidence clusters.

<p>OR, odds ratio; 95% CI, 95% confidence interval;</p>a<p>Missing data in demographic and bednet survey;</p>b<p>Not selected into final multivariate model based on higher than 10% Type I error on LR test.</p

Positive malaria cases and climatic factors per month, May 2010 to April 2012.

<p>Symptomatic <i>P. falciparum</i> infection numbers were correlated with (<b>A</b>) rainfall distribution (R² = 0.252; p = 0.007), (<b>B</b>) average daily minimum temperature (R² = 0.203; p = 0.016), and (<b>C</b>) average daily humidity (R² = 0.261; p = 0.006). Case numbers were not associated with (<b>D</b>) the average daily maximum temperature (R² = 0.002; p = 0.820). Rainfall distribution is defined by the average daily rainfall per month (in mm) multiplied by the number of rainy days in that month.</p

Box-plots of hemoglobin in pregnant and non-pregnant women with or without asymptomatic malaria.

<p>Box-plots represent the median and interquartile range of hemoglobin concentration. Panel <b>A</b> shows values in non-pregnant (n = 444) and pregnant (n = 495), <b>B</b>, malaria negative (n = 926) and malaria positive (n = 13), and <b>C</b>, the interaction of pregnancy and malaria indicating the lowest hemoglobin concentration in malaria-positive pregnant women (n = 10) compared with malaria-negative non-pregnant (n = 441) or pregnant (n = 485) women or malaria-positive non-pregnant women (n = 3). (Statistical significance by non-parametric Kruskal-Wallis equality of populations test)</p

Description of the study participants.

<p>Description of the study participants.</p

Prevalence of asymptomatic malaria infection by demographics.

<p>Prevalence of asymptomatic malaria infection by demographics.</p